title: Characterization of the enhancing lesions on dynamic contrast enhanced magnetic resonance imaging in patients with interstitial mammoplasty.
abstract: OBJECTIVE
  The purpose of this study was to categorize the morphologic and kinetic features of enhancing lesions in breasts with interstitial mammoplasty using dynamic contrast-enhanced magnetic resonance imaging and to assess factors predictive of breast cancer.
  
  
  METHODS
  We retrospectively reviewed the clinical and radiological data of 21 enhancing lesions in 19 patients with interstitial mammoplasty, who underwent breast magnetic resonance imaging and biopsy or an operation in our hospital from September 2008 to July 2012. These lesions were sorted by morphological and kinetic features and final assessment category according to the BI-RADS lexicon.
  
  
  RESULTS
  Nine cases were confirmed to be ductal carcinoma in situ (n = 2) and invasive ductal carcinoma (n = 7), and the remaining 12 cases were fibrocystic disease (n = 2), fibroadenoma (n = 2), fat necrosis (n = 1), foreign body granuloma (n = 3) and silicone mastitis (n = 1). Common features of malignancy included irregular shape (50.0%), spiculated margins (75.0%), heterogeneous enhancement (50.0%) and type III kinetic pattern (87.5%). The correlations of margins and kinetic curve pattern with benignity and malignancy approached statistical significance (p = 0.02, respectively). We found no correlation for shape (p = 0.33) or internal enhancement (p = 0.42) between lesion types. The malignancy rate of enhancing lesions was 42.8% (9/21). The sensitivity and specificity of dynamic contrast-enhanced magnetic resonance imaging were 100% and 16.67%, respectively. The positive predictive value, negative predictive value and accuracy of magnetic resonance imaging were 47.38%, 100% and 52.38%. Overall inter-observer agreement for the kinetic curve pattern was good (κ = 0.67). Moderate agreement was seen in describing the shape, margin, enhancement and assessing the final category (κ = 0.59, 0.46, 0.58 and 0.49, respectively).
  
  
  CONCLUSIONS
  Dynamic contrast-enhanced magnetic resonance imaging had a high sensitivity, negative predictive value for the prediction of breast cancer but a low specificity due to features of foreign body-related lesions that mimicked malignant lesions. The significant predictive factors for malignancy were margins, kinetic curve pattern and final assessment category. Overall inter-observer agreement for the kinetic curve pattern was good.
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Kim
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.forename: Hyeon Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Cha
authors.forename: Ji Youn
authors.initials: JY
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000209:etiology* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology*; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Breast implants; Magnetic resonance imaging; Mammoplasty; Paraffin; Silicones